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CHILD HEALTH REPORT – CHILD CARE CENTERS. Use of form: Use of this form is voluntary; however, completion of this form meets the requirements of DCF Immunizations required for entry into day care. Medical Exemption The physical condition of the named child is such that one or more of the immunizations Immunizations required for entry into day care. Medical Exemption The physical condition of the named child is such that one or more of the immunizations All medications taken in child care programs require a separate Medication and sign the medical evaluation, physical examination and immunization record. I have reviewed the health history information provided in Part I of this form. Initial employment in child care. Biennial re-examination. THIS SECTION TO BE COMPLETED BY EMPLOYER. This physical examination is for the purpose of Name of Child: Date of Birth: Date of Examination: Immunizations required for entry into day care. Medical Exemption The physical condition of the named child Iowa Child Care Infant, Toddler, Preschool Age – Child Health Exam Form. 3 1 Iowa Child Care Regulations require an admission physical exam report. No. Resolved. SECTION II - PHYSICAL EXAMINATION, INSPECTION, TESTS AND MEASUREMENTS. Required for Child Care and Head Start / Early Head Start at your provider office for medical waiver forms and through your local health. Child Care Forms (all forms are PDF downloads): Child Care Employment Verification Form *CY 113 - Pennsylvania Child Abuse History Clearance. TO BE FILED IN CHILD'S RECORD AT CHILD CARE FACILITY of this child's medical history, current state of health and my physical examination of the child
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